Platelet Inhibition Maintained With Pre-CABG Cangrelor

HealthDay News—For patients who discontinue thienopyridine treatment before coronary artery bypass graft (CABG) surgery, the use of cangrelor as a bridge is associated with higher maintenance of platelet inhibition compared with placebo, according to a study published in the Jan. 18 issue of the Journal of the American Medical Association.

Dominick J. Angiolillo, MD, PhD, from the University of Florida in Jacksonville, and colleagues investigated the use of cangrelor, an intravenous, reversible P2Y12 platelet inhibitor, for bridging thienopyridine-treated patients to CABG surgery. Thienopyridines were stopped in 210 patients who were randomly allocated to receive cangrelor or placebo for at least 48 hours; treatment was discontinued one to six hours before CABG surgery. Platelet reactivity was assessed daily, and the main safety end point was excessive CABG surgery-related bleeding.

The investigators found that low platelet reactivity was seen throughout the entire period in a significantly greater proportion of patients treated with cangrelor versus placebo (98.8 vs.19%; relative risk [RR], 5.2; P<0.001). Excessive CABG-related bleeding was seen in 11.8% of patients in the cangrelor group versus 10.4% of those in the placebo group (RR, 1.1; P=0.763). There were no significant between-group differences in major bleeding prior to CABG surgery. More minor bleeding episodes occurred in patients receiving cangrelor.

"Cangrelor achieved and maintained target levels of platelet inhibition known to be associated with a low risk of thrombotic events compared with placebo, without a significant excess in bleeding complications," the authors write.